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Anorexia nervosa disorder is one of the most well-known and, contradictorily, maybe one of the least understood mental health disorders in the United States. Most people have known someone with anorexia nervosa disorder personally, and may even have known someone who received anorexia nervosa treatment, but very few people are familiar with the causes or details of the disorder. One of the causes, though certainly not the only factor, may be a sense the individual is “too fat” or that there are weight-related flaws in their body, no matter how much weight is lost. This is known as a distorted body image, and is all too common in cases of anorexia nervosa disorder.

As characterized by experts at anorexia nervosa treatment centers, anorexia nervosa may impact the individual so they make efforts to achieve extreme weight loss. Almost always, this means people with anorexia nervosa severely restrict their caloric intake, by avoiding meals entirely, eating only tiny portions and eating foods with negligible nutritional value. Additionally, extreme exercise regimens, purging (more commonly associated with bulimia nervosa), and laxative abuse may be present.

Along with these symptoms, a negative or distorted body image almost always accompanies the onset of anorexia nervosa.  According to the National Eating Disorder Association (NEDA), it is one of the main criteria of anorexia nervosa.

Adolescence Can Be the Turning Point

The average age of onset for cases requiring anorexia nervosa treatment is 18, which means a statistically significant number of girls and young women with the disorder are in middle to late adolescence. In almost all these cases, a distorted body image is present before the development of the eating disorder. As we will see, issues with body image can be in comparison to classmates, due to parental pressures, from exposure to media (both the traditional and social varieties), cultural norms, and related mental health disorders. In many cases, the distortion of a girl’s body image begins well in advance of the onset of anorexia nervosa.

Shockingly, in recent years there has been a marked increase in the incidence of dissatisfaction with their bodies in girls beginning as early as ages six to twelve.

Beyond the specific health risks that can require anorexia nervosa treatment, which we will outline below, anorexia nervosa normally begins at a universally critical time in human development – adolescence. During this time, children begin to experience the physical and hormonal changes of puberty, experiencing new emotional development and physical changes at a rapid pace. Additionally, puberty is a time where physical attractiveness, however capricious it can be, dating, and sexuality enter an adolescent’s life. Add into the mix the intense personality development and social interaction as the adolescent moves into adulthood, and this becomes perhaps the most critical time in anyone’s life.

What We Have Learned About Body Image and Anorexia Nervosa

At anorexia nervosa treatment centers such as Clementine, decades of shared experience have highlighted some common ways a distorted body image can take hold. Adolescents are highly susceptible to peer pressure, parental pressure, and cultural / media expectations and all of these can prevent a positive relationship with and acceptance of their bodies – and this troubled perception of their weight and body shape can be a major contributing factor for anorexia nervosa.

With the lessons we have learned at our anorexia nervosa treatment centers, here are four facts about distorted body image:

Parental Pressure and Genetics

The “nature versus nurture” debate as it pertains to mental health disorders, including anorexia nervosa, is highly complex. Most experts at anorexia nervosa treatment centers agree there is a genetic component to these disorders, in that the tendency to develop symptoms of an eating disorder may be passed down from a family member who has struggled with one in the past. This is similar to the inherited nature of other mental health disorders such as OCD or depression, in that there is a genetic predisposition present to develop the disorder, and also the natural tendencies for children to mimic their parents’ or caregivers’ behaviors.

On the other hand, a distorted body image can be imparted (often unknowingly) by parents. This can be observed most readily by parents who engage their children in weight-pressured activities. Example of this can include ballet, swimming and diving, wrestling, beauty pageants and other activities which place a premium on weight, body fat and strictly defined “attractiveness.”

None of this is to say these activities are inherently “bad” or cause eating disorders. Accordingly, parents who encourage their adolescent children to take part in them are not doing anything wrong. It is important to allow children to explore their interests and passions as they develop into adults. However, the pressure to conform to standards of body weight or shape, or to cultural expectations of beauty of attractiveness as they relate to “thinness” can become a contributing factor in body image distortions.  Parents should encourage their children to pursue these activities with reminders that self-acceptance of one’s body is a key to emotional balance. This can go a long way to alleviating the pressures caused by both genetic and activity-based pressures.

Peer Pressure

According to studies, 40% of the 5th grade female students surveyed felt dissatisfaction with their bodies.  At a developmental stage of life as turbulent as the ten to thirteen years old range, young people experience rapid changes in their body size and shape, all the while being surrounded by people the same age who are experiencing similar changes. When added to the intense emotions normally encountered during early to middle adolescence and the beginnings of adult socialization, it is quite normal to feel dissatisfaction with one’s body. However, the intense desire to be attractive, cultural and media norms conflating “skinniness” or “thinness” with beauty, and the presence of bullying can all contribute to a distorted body image at this age.

Peer pressure does not necessarily mean overt bullying. We have all heard or even experienced stories of a child being mocked for their weight. In a public setting, more than one peer may have joined in on the teasing. This, of course, can cause intense feelings of self-loathing and shame in the target, who may swear to themselves to change their weight, so they won’t have to endure mocking in the future. This, unfortunately, can lead to the sense the individual is “fat” or otherwise unattractive, even when medically deemed underweight, a classic symptom of anorexia nervosa.

While overt taunts and insults certainly do occur and can have serious effects on an adolescent’s self-image and self-worth, peer pressure can have more subtle effects on teenagers. A girl may not be subject to bullying or taunting at all and still develop a distorted body image. One example could be if a close friend decides to go on a diet. She might eat an extremely light school lunch and say something to her friend like, “I can’t believe you still eat pizza! Don’t you worry about getting fat?” This kind of interaction, while not mocking, can still serve as a subtle form of “fat-shaming” which can erode a person’s self-image and contribute to the development of a disorder which may require anorexia nervosa treatment.

Traditional Media

Beginning in the early 20th century, Americans have been bombarded daily with images of “beautiful” people and lifestyles. Whether it is the escapism of Hollywood, the glamor and spectacle of the fashion world, or even the inescapable presence of advertising, both teenagers and adults are exposed to images and videos of what are deemed to be attractive people on a daily basis. In Western culture, perhaps, unfortunately, “attractive” all too often means “skinny.”

This may have reached its peak in the 1990s and early 2000s when models exemplifying “heroin chic” trends put tremendous value on being thin, even to the point of being emaciated. What made these trends so insidious is that these models often had eating disorders, but instead of seeking help, they were promoted as the ideal for beauty.

It is natural to see what is being sold as the standard of beauty or attractiveness and compare this to yourself. The issue comes to a crisis point when an individual’s self-worth suffers as they attempt to reach an unattainable standard, and when an unrealistic body size or shape becomes the goal. When observing a model as an exemplar of what it means to be attractive or sexy, a teenager with a rapidly changing body (not to mention a natural body shape which may differ from this example) can quickly begin to “fat-shame” herself even beyond parental or peer pressure.

This unreasonable sense of “skinny as beauty” is exacerbated by the widespread use of Photoshop and other image-altering tools in advertising, especially in advertising aimed at women. Makeup and clothing advertisement often feature famous models and actresses, but the final photo used is hardly the real image. This all culminates in an even more unattainable standard of attractiveness, even to the point of being humanly impossible.

Social Media

A relatively new factor in affecting body image, social media platforms can combine the influence of peer pressure and traditional media. For today’s teenagers, who have never lived in a world without social media, this can mean they are comparing themselves not only to professional models but to everyday people and even their peers, all of whom are presenting an idealized version of themselves. Combined with the promotion of lifestyles such as fad diets and extreme workouts, social media can show teenagers a world that looks like real life, muddying the difference between fantasy and reality.

When posting on Facebook or Instagram, people tend to put up images and status that put them in the best possible light. This means, in practice, they will post images that make them “look skinny,” often with flattering angles or even filters which artificially make the poster seem thinner than they really are.  In a similar vein, they may post images and descriptions of a diet program (many of which promote an unhealthy relationship with food and eating in the name of “thinness”). While body positivity and self-acceptance certainly have voices on social media, this is often counteracted by “influencers” (essentially paid advertisers) who serve the same purpose as a professional model in a magazine ad.

The true difficulty springing from social media as regards adolescent body image is that it presents an idealized version of “real people,” combining the promotion of thinness found in traditional media with the subtle peer pressures of a school environment.  These factors can engender a distorted self-image in impressionable adolescents.

Be Aware of the Contributing Factors

Treatment at an anorexia nervosa treatment center may be necessary for adolescents whose distorted body image has led to the development of an eating disorder.  Part of this treatment normally involves therapeutic methods such as Cognitive Behavioral Therapy (CBT) and others to help normalize a more positive body image and greater self-acceptance.  The various pressures to conform to beauty and attractiveness standards from parents, peers, and traditional and social media can be powerful but they can be overcome.  If your daughter has been diagnosed with anorexia nervosa or another eating disorder, give the compassionate professionals at Clementine a call today at 855.900.2221, and begin the path to a recovered life.

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Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.